2015 ISAKOS Biennial Congress ePoster #1502

Correlation Between Histological Outcome and Surgical Cartilage Repair Technique in the Knee: A Meta-Analysis

Alex C. Dibartola, MD, MPH, Columbus, OH UNITED STATES
Josh Everhart, MD, MPH, Columbus, OH UNITED STATES
Robert A Magnussen, MD, MPH, Worthington, OH UNITED STATES
James L. Carey, MD, MPH, Philadelphia, PA UNITED STATES
Robert H. Brophy, MD, Chesterfield, MO UNITED STATES
Laura C. Schmitt, PT, PhD, Columbus, OH UNITED STATES
David C. Flanigan, MD, Columbus, OH UNITED STATES

The Ohio State University College of Medicine Department of Orthopedics, Columbus, OH, USA

FDA Status Not Applicable

Summary: This study compares the histology of repair cartilage after microfracture, autologous chondrocyte implantation with periosteal or collagen covers, matrix-induced autologous chondrocyte implantation, and osteochondral autograft transfer.

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Abstract:

Correlation between Histological Outcome and Surgical Cartilage Repair Technique in the Knee: A Meta-Analysis

Alex C. DiBartola, BS; Josh Everhart, MD MPH; Robert A. Magnussen, MD MPH; James L Carey, MD MPH; Robert H. Brophy, MD; Christian Lattermann, MD; Laura C. Schmitt, PhD; David C. Flanigan, MD

The Ohio State University Department of Orthopedics
Wexner Medical Center, Columbus Ohio

Objective

Cartilage defects can cause substantial patient morbidity and predispose patients to chronic knee problems such as osteoarthritis (OA). Numerous treatment options have been described with variable results. The objective of this study was to compare the histology of repair cartilage after microfracture (MF), autologous chondrocyte implantation with periosteal (ACI-P) or collagen (ACI-C) covers, matrix-induced autologous chondrocyte implantation (MACI), and osteochondral autograft transfer (OAT).

Methods

A review of the existing literature was performed using PubMed MEDLINE, SCOPUS, Cumulative Index for Nursing and Allied Health Literature (CINAHL), and Cochrane Collaboration Library databases. Human studies that used biopsy or International Cartilage Repair Society (ICRS) grading criteria to grade repair cartilage after MF, ACI-P, ACI-C, MACI, or OAT were included. A meta-analysis using a random effects model was performed utilizing a modified ICRS score to compare the results of the different techniques.

Results

Thirty-three studies investigating 1,511 subjects were identified that met inclusion criteria. Thirty of the studies evaluated ACI, six evaluated MF, and seven evaluated OAT. There was no evidence of publication bias in the included studies (Begg’s p=0.48). Microfracture had significantly lower modified ICRS scores than ACI-P (p=0.005) and MACI (p=0.02) and a trend toward a lower score than ACI-C (p=0.07) and OAT (p=0.19). No difference was found in ICRS scores between ACI, MACI, ACI-C, and OAT (p>0.25). There was no association between the mean modified ICRS score and average length of follow up (p=0.31), study design (p=0.11), average defect size (p=0.91), or percent male patients (p=0.08). Post-hoc testing revealed no statistical difference between MACI, ACI-C, and ACI-P as it relates to percent hyaline cartilage at follow-up. A higher percentage of biopsies with mostly hyaline cartilage was found for OAT than ACI-P, MACI, and ACI-C (p<0.0005), and a lower percentage was found for microfracture than all other groups (p=0.003).

Conclusions

Microfracture has poorer histologic outcomes than other cartilage repair techniques. OAT produces repairs that are more likely to be comprised of hyaline cartilage, followed closely by cell based techniques, although there is not a significant difference in the quality of cartilage as assessed by the ICRS grading criteria among OAT, ACI-C, MACI, and ACI-P.